Depression in Older Adults

About this leaflet

This leaflet is written for people over 65 who have depression.
We hope it will also be helpful for relatives, friends and carers.
It covers

the symptoms of depression

how it can be helped

some suggestions for further reading.

Introduction

Everyone feels sad sometimes. But later life can give you more
reasons to feel down. You may have to deal with:

stopping work

having less money

health problems

the death of a partner or friends.

Most older people cope well in spite of these difficulties.
However, depression can affect 1 in 5 older people living in the
community, and 2 in 5 living in care homes. If you do get
depressed, there is help available for you which works, as
there is for younger people.

What is it like to have depression?

Feeling low or sad is not the only sign of depression. You
may:

Lose interest in life - you can't enjoy the things you usually
do.

Feel tired for no reason. You just don't feel like doing
anything. Simple things take a big effort.

Lose your appetite - and weight.

Feel restless - and find it hard to relax.

Worry more than is usual for you.

Want to avoid people.

Feel snappy or irritable with people.

Sleep badly. You may wake an hour or two earlier than usual and
find that you can't get back to sleep.

Lose confidence in yourself.

Feel useless or a burden to others.

Notice that you can't concentrate properly.

Feel panicky.

Lose your sexual feelings.

Feel bad or guilty. You dwell on things from the past and may
get things out of proportion.

Think about suicide - at some point most people with severe
depression will feel like ending it all.

Particular problems for older people

Physical symptoms and depression
Some physical illnesses can give you symptoms that are similar
to those in depression. For example, loss of appetite
or poor sleep can be caused by thyroid problems,
heart disease or arthritis.

Long-term
illness
If you become depressed, you may start to get more upset by your
health, even though it hasn't really changed for the worse.
Treating the depression can't take away physical
health problems, but it can make them much more
bearable.

Confusion and memory problems

Depression, worry and anxiety can affect your memory and make
you feel confused. You may worry that you are suffering from
dementia (a permanent loss of memory) when it is actually just
depression.

A new sense of loneliness

Living alone does not automatically make you depressed. But
feeling more lonely for no obvious reason may be a sign of
depression.

Getting help

If you have strong feelings of depression, do take them
seriously. They are not a sign of weakness, but you may need to get
some help.

How do you know when it's time to get
help?

If your feelings:

are worse than you would expect

have gone on for several weeks

interfere with your life

mean that you can't face being with other people

make you feel that life is not worth living

worry you are causing concern to friends or family

include thoughts of harming or killing yourself.

What should you do?

Talk to your GP. They are quite used to helping
people with depression and will know what to do. You
are not wasting your GP's time by asking for
help. If you can't get out, ask your GP to see you at
home. You may find it helpful to take a friend or
relative with you when you see your GP.

I don't want to bother the doctor - depression isn't a
real illness

Older people tend to think more about physical problems than
about feeling depressed. You may have been brought up not to bother
the doctor unless you have a physical complaint. Sometimes the
first sign of depression can be a constant worry about having a
physical illness, even when your doctor can't find anything wrong
with you. If he or she tells you that you are depressed, it may
feel as though you are not being taken seriously. This isn't the
case. Depression can be treated just like any
illness.

Why do people get depressed?

When we are depressed, we tend to blame ourselves; this is
because depression makes us see things in a very negative way. We
may start to blame ourselves for things that we are not responsible
for.

Painful events. Depression
can come out of the blue. More often it is triggered by something,
like the death of a partner or close friend. Some of us are just
more likely to get depressed when faced by a difficult or painful
situation - it's our temperament. Women seem to be more likely to
get depressed than men, but men may just find it harder to talk
about.

Past depression. You are
more likely to get depression if you have had it
before.

Physical illness can make you feel
depressed, such as a problem with the thyroid gland. Your
doctor can check this.

Any physical illness can trigger depression.
This can be sudden, like a stroke, or long and disabling, like
Parkinson's disease. It may be several illnesses which have taken
their toll over the years. Although this may make the depression
more 'understandable', it doesn't mean that it can't be helped.
This type of depression often responds very well to
treatment.

Medicines. Depression can be caused by some
medications. You can ask your doctor or pharmacist about
this.

Helping yourself

Ask for help: It's the same at any
age, you don't have to put up with being depressed. Tell your
GP how you feel.

Keep active: It can be hard to get our
regularly because of physical problems, but it's worth doing. We
know that if you keep up some regular physical activity, you tend
to feel better. And if you are alone at home, you are
more likely to brood on things, which can make you feel even
worse.

Stay connected: It helps to keep your mood up
by:

keeping up with hobbies and interests

staying in touch with friends and family

visiting your local library or local lunch clubs and day
centres.

Try to eat properly: If you lose your
appetite, it's easy to lose weight and run short of important
vitamins and minerals. Older bodies cannot adjust as well as
younger ones - so this can really affect your health. Beware
of stocking up on chocolate and biscuits - these are quick and easy
to eat, but they don't have the vitamins and minerals to keep you
feeling well.

Remind yourselfthat depression is an illness - not a sign of
weakness. You are not being lazy or letting other people
down.

Tell
someoneif you feel so low that you have
thoughts of taking your own life.

Don't keep your feelings to yourself. Talking
to somebody does help.

Watch your drinking. Alcohol can make
depression worse. It can also react with any tablets you are
taking.

Try not to panic about
not sleeping properly. It will get better when the
depression lifts.

Try not tochange the tablets you are on without discussing it with
your doctor. If your tablets have side-effects, tell
your doctor or nurse.

Be kind to yourself - you may need to change
your routine while you are unwell.

Try not to think that
depression causes dementia. It doesn't.

Treatments for depression

Talking treatments

It can help to talk to a good listener. This could be a friend,
a relative, a volunteer or a professional. If this is not enough,
professionals can offer special ways of talking which include:

Psychotherapy: which helps you
to see how your depression may be connected with what has
happened to you in the past.

Cognitive Behavioural Therapy:
which helps you to see how some of the ways you think or
behave may be making you depressed. It then helps you to think
in more realistic ways that make you feel better.

Are there problems with talking
treatments?

They are very safe. But, sometimes psychotherapy can bring up
unhappy memories from the past. A good therapist will know how to
deal with this. If you have concerns, you should discuss them with
your GP or therapist.

Your GP or another professional can arrange treatments
like these, although there may be a waiting list. Local
organisations and charities may provide counselling or talking
therapies free of charge. Ask your GP what is available
locally.

If your depression has been triggered by bereavement or
problems in a relationship, then bereavement counselling
or couples therapy can help.

Antidepressant medications

If you are depressed and have poor sleep, poor appetite and loss
of weight (or over-eating and weight gain), or the depression has
gone on for a long time, your doctor will often suggest an
antidepressant. About 50-60% of people who take these tablets will
find they help. There are several types of antidepressant now
available, so it should be possible to find one to suit
you.

Do antidepressants have side-effects?

You may feel sick or more anxious over the first few
days, but these effects usually wear off. Some may make you
sleepy or give you a dry mouth. They can sometimes interfere with
other medicines, but your doctor will be aware of this.

In older people, antidepressants can lower the amount of salt
(sodium) in the blood - this can make you feel weak and
unsteady.

About 1 in 3 people can get withdrawal symptoms if
they stop these medicines suddenly. So it's best to come off them
slowly. To find out more, read our leaflet on antidepressants.

Antidepressants take 1 or 2 weeks to start working. You
may find that it takes 6 to 8 weeks for them to really make a
difference. Don't drive if they make you sleepy or if they slow
down your reactions - if this happens, mention it to your
GP.

Many older people are already taking medication. If you add an
antidepressant, you may find it hard to keep track of which tablet
you should take, and when you should take it. To help with this,
your doctor or chemist can give you a special box, or blister pack.
This has all the tablets set out in separate compartments for each
time and day of the week.

St John's Wort

This is a herbal antidepressant that you
can buy from a chemist without a prescription. It has fewer
side-effects than prescribed antidepressants, but is not effective
in more severe depression. It can be harmful if taken with some
other medications - so, if you are taking other medication, ask
your GP about this.

Electroconvulsive Therapy (ECT)

Electroconvulsive therapy (ECT for short) can
be used:

In severe depression, if the person's life is at risk and they
need urgent treatment

In moderate or severe depression, when no other treatment has
helped.

ECT involves passing an electric current through the brain,
so is always given in hospital under general anaesthetic. Some
people have memory problems after ECT. See our leaflet on
ECT for more information.

Practical help

You may become depressed because you are living in poor
housing, can't keep your home as you would like it or you don't
feel happy where you live. If so, a social worker can help you to
get advice on financial or practical support - or even moving
house. But do be careful, it is easy to make a bad decision about
moving when you are depressed. It is usually best
to put off big decisions like this until you are feeling
better.

Professionals can also help you find ways to spend
time with other people. This can be important because it's easy to
lose touch with people when you are depressed. There are lunch
clubs, day centres and support groups where you can go. It's really
important to talk with or just to meet other people. It
will help.

Which treatment is best?

Everyone can try the simple steps in this leaflet. Talking
treatments and antidepressants work equally well. Your GP is more
likely to recommend antidepressants if your depression is severe,
or has gone on for a long time.

Antidepressants work a bit faster than talking
treatments. Some people prefer talking treatments, whilst others
prefer tablets. You can have both at the same time. Your GP will be
able to give you advice. It may also help to talk over the options
with your family or a close friend.

What if depression is not treated?

Most people will get better, after weeks, months or even a year or
two, but the shorter the depression lasts, the better. The simple
steps outlined in this leaflet may be enough to help you feel well
again. If the depression is so bad that you are not eating or
drinking enough, you can become dangerously ill. It may give you
thoughts of suicide.

Seeing a specialist

Although most people get better at home with these treatments,
some people do not. If this happens, your GP may ask
a specialist to see you for some expert advice. That does not
mean that people think you are 'mad'. Your GP may need a
second opinion or advice about the best treatment for you.

In Britain most places have psychiatrists who specialise
in helping older people with depression. They usually work as part
of a specialist mental health team, so you will usually see a
nurse or a social worker first.

The first interview with someone from the team takes
about an hour. If you are depressed, you may find it difficult to
remember some of the details of how it all began. If so you can ask
a friend, neighbour or relative to be present with you. It
can also help to write down your ideas before the interview.

Going into hospital

If you are very unwell - perhaps unable to eat or drink, or have
tried to kill yourself - you may need the safety of a hospital.
Only a small number of people with depression become this
unwell.

Staying well

Nobody wants their depression to come back again. To stay
well, it is best not to stop the antidepressants until
your doctor advises you to - even if you have
been feeling well for a while. There's a chance of the
depression returning if you stop taking your tablets too
soon.

If your general health is good and this is your first
depression, you will probably need to stay on the tablets for 6 to
12 months. If you have already had depression several times, your
doctor may recommend that you stay on an antidepressant for
longer.

Talking treatments, like Cognitive Behavioural Therapy, can
also help to prevent depression coming back.

Do go through the section on 'self-help' above. These things
will all help you to stay well - and to feel that you have some
control over what is happening.

For relatives and friends - how can you help?

You may be the first person to notice the depression. Encourage
them to get help. Tell them that depression is quite common, it can
be treated and that they will get better. They may need to be
reassured that they are not "going mad". You can suggest that they
see their GP - and offer to go with them.

People with depression get tired easily. Try to offer some
practical help, like shopping or cleaning for them. They may need
reminding to eat properly.

Don't force them to talk. Just being with someone is often
helpful.

Don't push them into doing things. It can help to get out
and do some gentle physical activity - but it may
not help if you have to nag them to do it. In fact, people will
often dig their heels in if they feel they are being put under too
much pressure. It may be more acceptable for you to offer to go
with them to something they want to do - a lunch club, a day
centre, library or interest group.

Be patient. Depression can make someone constantly ask for
reassurance or become convinced that they've got something
physically wrong with them. It's often because they are frightened
or don't understand what is happening to them. Reassure them as
much as you can and try to spend time listening. You may need to
reassure them that they are not "losing their mind".

Don't be embarrassed to ask if they have felt suicidal. Most
people who feel like this are just relieved when someone asks about
it. Talking about it will help.

You can become exhausted while caring for someone with
depression - and then it is important to ask for help
yourself. The specialist mental health team can give you a
break by arranging for them to go to a day centre or
day hospital. They are also there for you to talk to.

Finally, be cautious of making decisions about
housing or accommodation when someone is depressed. They may
put pressure on you and say that how they feel is all to do with
where they live. But things are not usually that simple. People who
move when they are depressed may regret it once they are better.
Remember that social services may be able to help with self-care,
meals and finances.

Don't judge and do be supportive - depression is an illness
which can be helped.

References

Effects of exercise on depressive symptoms in older adults
with poorly responsive depressive disorder. Mather AS et
al. (2002) British Journal of Psychiatry, 180,411-415.Cross-cultural comparison of depressive symptoms in Europe does
not support stereotypes of ageing. Copeland JR et al.
(1999) British Journal of Psychiatry, 174,322-329.

Further Reading

Reading Well Books on Prescription helps you manage your well-being
using self-help reading. The scheme is endorsed by health
professionals, including the Royal College of Psychiatrists, and is
supported by public libraries.

This leaflet had been produced by the Royal College of
Psychiatrists' Public Education Editorial Board.